After Appeal Filed

What happens after I file my appeal?

The Appeals Section reviews each appeal to see if a hearing can be granted. Each appeal must meet the following criteria:

The Department has taken an action that can be appealed.

The Department has issued a written notice about the negative action.

You filed your appeal:

- within 15 calendar days for tax/debtor offsets.

- within 90 calendar days of the written notice for Food Assistance and Medicaid.

- within 90 calendar days for a child abuse assessment.

- within 6 months for an adult abuse assessment.

- within 30 calendar days of the written notice for all other programs.

For managed care organization appeals, the Appeals Section will also:

Confirm that the first level review process through the managed care organization has been exhausted, and

Member has provided written authorization for the provider to file an appeal on their behalf, if applicable.

If you are eligible for a hearing, the Appeals Section will send your appeal file to the Department of Inspections and Appeals-Division of Administrative Hearings. They will schedule a telephone hearing and send you a written notice of the date and time.

If you do not get a hearing, the Appeals Section will send you a letter telling you why your appeal was denied.

Can I file a new application while my appeal is pending?

You can file a new application at any time. If your situation changes during the appeal, contact your DHS worker and ask to reapply right away.

You may be eligible for assistance even if the administrative law judge hasn't made a decision yet.

Can I keep my benefits while my appeal is pending?

You may continue to get benefits while your appeal is pending, however, any benefits you get while an appeal is pending may be subject to recovery. If the Department is found to have acted correctly, you will be responsible for repaying the Department for any assistance that you were not entitled to while your appeal was pending. If the Department is found to have acted incorrectly, you may not have to repay funds received while an appeal is pending.

You can choose not to have benefits continue while your appeal is pending. If you choose not to, you should indicate that on the Appeal and Request for Hearing form.

The Department’s regulations define the criteria that is used to determine if benefits can continue while an appeal is pending. The criteria differs based on the type of assistance you receive.

Food Assistance:

Your Food Assistance benefits may continue pending a final decision on your appeal when you ask for an appeal hearing within 10 calendar days from the date of the Notice of Decision that reduced, suspended, restricted or canceled your benefits was received. The date the notice is received is considered to be 5 days after the date on the notice, unless you show that you did not receive the notice within the 5 day period.

Managed Care Organization:

Health care services may continue pending a final decision on your appeal when:

An appeal is filed timely. Timely means the appeal is filed on or before the effective date of the adverse benefit determination or within 10 calendar days from the date of the managed care organization’s notice reducing, limiting, suspending, or canceling health care services was received. The date the notice is received is considered to be 5 days after the date on the notice, unless you show that you did not receive the notice within the 5 day period;

The appeal involves the termination, suspension or reduction of a previously authorized course of treatment;

The services were ordered by an authorized provider;

The original period covered by the original authorization has not expired, or

The appellant requests their health care services be continued.

If the managed care organization continue or reinstates the member’s health care services while the appeal is pending, the benefits will continue until:

The appellant withdraws the appeal.

The appellant fails to request an appeal within ten calendar days from the date the managed care organization mails the notice of action.

The authorization for services expires or authorization service limtis are met.

A hearing decision is issued that is adverse to the appellant.

For all other programs, benefits may continue if:

You file your appeal within 10 days from the date of the Notice of Decision that reduced, suspended, restricted, revoked, canceled, or denied assistance to you or your household was received. The date the notice is received is considered to be 5 days after the date on the notice, unless the appellant shows that he or she did not receive the notice within the 5 day period.

You file your appeal before the effective date on the Notice of Decision, unless your certification period has ended.

What do I do if the issue of my appeal is resolved or I no longer want to pursue my appeal?

If the issue of your appeal has been resolved or you no longer want to pursue the appeal, you may request to withdraw your appeal.

Request to Withdraw Appeal

To request to withdraw an appeal, you may do so by telephone, in writing or in person. For child abuse and dependent adult abuse appeals, the request to withdraw must be done in writing and signed by the appellant and their legal counsel.

You may write a letter explaining that you wish to withdraw your appeal and mail, fax or email your request or you may complete the form Request to Withdraw Appeal online[1]. Please complete the entire form and click the submit button at the bottom of the form. Your request to withdraw your appeal will be sent directly to the Appeals Section. Your worker will be notified of your request, if applicable.

You will get a letter from the Appeals Section indicating that your request was received.

If a hearing has already been scheduled, you may submit a written request to the Administrative Law Judge directly to let them know you are no longer interested in having a hearing.